胃と腸49巻6号

2014年05月発行

今月の主題 Helicobacter pylori陰性胃癌 主題

Helicobacter pylori陰性分化型胃癌の臨床病理学的特徴―臨床の立場から

著者： 八板弘樹¹ 蔵原晃一¹ 川崎啓祐¹ 大城由美² 河内修司¹ 森下寿文¹ 長末智寛¹ 阿部洋文¹ 澤野美由紀¹ 高橋郁雄³ 八尾隆史⁴ 渕上忠彦¹

所属機関： ¹松山赤十字病院胃腸センター ²松山赤十字病院病理部 ³松山赤十字病院外科 ⁴順天堂大学医学部人体病理病態学

ページ範囲：P.863 - P.873

要旨　Helicobacter pylori（H. pylori）陰性分化型胃癌の臨床病理学的特徴を明らかにするために，H. pylori除菌歴のない自験胃癌切除例を対象としてH. pylori陰性胃癌を抽出し，特にH. pylori陰性分化型胃癌の臨床病理学的所見を遡及的に検討した．当センターにおいて内視鏡的ないし外科的に切除された胃癌1,065例のうちH. pylori陰性胃癌は14例（1.31％）であった．14例は分化型癌8例（57.1％），未分化型癌5例（35.7％），粘液癌1例（7.1％）に分類された．分化型癌8例中6例（75％）が低異型度胃型高分化型腺癌で，5例（62.5％）がいわゆる胃底腺型胃癌であった．また，胃底腺型胃癌は対象1,065例中10例（0.94％）を占め，H. pylori現感染もしくは既感染5例，未感染5例であった．胃底腺型胃癌の内視鏡的特徴として，萎縮のない胃底腺領域に発生し，表面に血管透見像を伴った褪色調の病変であることが多かった．また，超音波内視鏡検査（endoscopic ultrasonography ; EUS）で粘膜深層から粘膜下層でのhypoechoic lesionを6例中4例（66.7％）に認め，胃底腺型胃癌の特徴的所見である可能性が示唆された．今後，H. pylori感染率の自然低下が予想される中で，H. pylori陰性胃癌のさらなる実体解明が重要と考えた．

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